By Dr. Frances M. Russell, Department of Emergency Medicine, Indiana University School of Medicine
For decades, EMS providers have been limited in assessing patients based on external signs and symptoms observable in the field. The inability to perform internal imaging has been a significant constraint in prehospital care. However, a recent study I conducted with researchers at the Indiana University School of Medicine has found that a device the size of an electric razor could fundamentally change how EMS professionals diagnose and treat acute heart failure in the field. More than an incremental improvement, it’s a significant advance in prehospital care that could redefine the role of EMS professionals and dramatically improve patient outcomes.
Acute heart failure (AHF) is a condition that affects millions of Americans annually, often presenting with symptoms that can be easily mistaken for other respiratory issues. This ambiguity has long posed a challenge for EMS professionals, who must make rapid decisions with limited diagnostic tools.
Traditional assessment methods have fallen short of expectations. The study revealed a startling statistic: without advanced tools, paramedics correctly identified AHF in fewer than a quarter (23%) of cases. This low rate of diagnosis leads directly to delays in treatment. Although not yet studied, these delays potentially extend hospital stays and increase mortality rates.
The study trialed a new tool for prehospital use: Butterfly Network’s handheld, point-of-care ultrasound (POCUS) device. This compact technology allows paramedics to perform lung ultrasound exams quickly and efficiently, providing crucial insights into a patient’s condition.
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Small device, big impact
When equipped with this POCUS device, paramedics’ ability to accurately diagnose AHF skyrocketed to 85%. This dramatic improvement didn’t come at the cost of overdiagnosis, either. The specificity remained high at 96%, indicating very few false positives.
The Butterfly device’s combination of portability, versatility and advanced technology makes it particularly well-suited for prehospital use, where space is limited, and conditions can be challenging. Its ease of use and AI-assisted interpretation also makes it ideal for EMS professionals without extensive ultrasound technology training.
The impact of this technology extends beyond improved diagnostic accuracy. The study revealed additional key benefits:
- Rapid initiation of treatment. Without lung ultrasound, only 14% of AHF patients received appropriate therapy before reaching the hospital, but with lung ultrasound, this number jumped to 53%.
- Reduced time to treatment. The median time from first patient contact to the start of heart failure therapy plunged from nearly 3 hours to just 21 minutes when lung ultrasound was used.
- Potential for improved outcomes. While long-term effects weren’t measured in this study, the dramatic reduction in time-to-treatment suggests the potential for significantly improved patient outcomes.
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Easy, cost-effective implementation
One of the study’s most encouraging aspects was its relatively simple implementation process. Paramedics were trained using a focused program that included 30 minutes of instructor-led classroom training, followed by 30 minutes of hands-on scanning practice and a short assessment.
The study employed a simplified four-view lung ultrasound protocol, focusing on identifying B-lines — telltale signs of fluid in the lungs often associated with heart failure. This streamlined approach makes the technology accessible even in the high-pressure environment of prehospital care.
While the benefits are clear, some might question the feasibility of widespread implementation. Concerns about cost and logistics are valid, but several factors suggest these hurdles are surmountable. As technology advances, handheld ultrasound devices are becoming more affordable — and higher quality. Meanwhile, improved early diagnosis and treatment could lead to shorter hospital stays and better outcomes, potentially offsetting implementation costs. And, while this study focused on AHF, handheld ultrasound has potential applications for various other conditions, increasing its value to EMS agencies.
Next steps for EMS agencies
For paramedics and EMTs, the introduction of handheld ultrasound represents an opportunity to enhance their skills and provide better patient care. It empowers first medical responders to make more informed decisions in the field, potentially saving lives and improving outcomes.
EMS agencies considering implementing POCUS devices like the Butterfly handheld probe should:
- Investigate training programs and requirements
- Conduct cost-benefit analyses
- Engage with local hospitals to establish protocols for lung ultrasound and interpretation
- Stay informed about ongoing research in this rapidly evolving field
The results of our study present a compelling case for the widespread adoption of handheld ultrasound in prehospital care. For EMS leaders, it’s time to consider how this technology could be integrated into your agency’s practices. For individual EMS professionals, staying informed about these types of advancements and advocating for their adoption could help shape the future of prehospital care.
As we look to the future, one thing is clear: integrating advanced diagnostic tools like handheld ultrasound can potentially transform emergency medical services. By bringing the power of rapid, accurate diagnosis to the field, we can provide better care for patients when they need it most — in those critical moments before they reach the hospital doors.
ABOUT THE AUTHOR
Frances Russell, MD, is a tenured professor of emergency medicine and the ultrasound research director in the division of ultrasound at the Indiana University School of Medicine. She earned her Doctor of Medicine at the University of Wisconsin, Madison School of Medicine and Public Health. She has over 50 peer-reviewed publications, has received grant funding from the NIH NHLBI and American Heart Association, in 2021 received the Society of Academic Emergency Medicine (SAEM) Academy of Ultrasound (AEUS) Academic Excellence award, and in 2023 received the SAEM AEUS Most Influential Researcher award. Dr. Russell currently serves as an American College of Emergency Physician (ACEP) ultrasound research subcommittee co-leader and previously served on the SAEM AEUS executive committee as the research officer.